One of the most frustrating things that can happen when billing is when a claim is denied and your claim was a “clean claim”. Here are some ways for physician offices to strategize ways to minimize and hopefully avoid a denial or waiting a long period of time for payment.
The very best time to resolve a potential problem with third-party payers is before a problem happens. One way is to build relationships with various provider representatives. A cooperative and professional understanding can be established through ongoing communication.
By identifying carriers that can at times be a problem is helpful when determining who to target when trying to build a relationship with. Make a spreadsheet which pinpoints who these payers are and if there record shows that they consistently fail to pay within 90 days of submitting the claim. Show in different columns how many times claims have to be resubmitted, what proportion of claims are rejected, the dollar amount of the claims submitted compared to the amount received and the time between the claim being submitted and when the payment was received.
These facts are good statistics to provide a pattern to the payer and hopefully persuade them to improve the promptness of their reimbursement patterns. For the most part, insurance payers require that a physician’s claim be submitted within 90 days. Is this being done?
To analyze this date properly, the medical biller should review past payments and EOB’s in order to identify these problems before submitting more claims. The insurance payer also has a responsibility within their contract that denotes a deadline for which they must send reimbursements. When submitting a clean claim to insurance payers; you have the right to expect payment within 90 days of submission.
Another way to examine rejections from payers is classifying them by CPT or ICD codes which can also be a way to see if for whatever reasons these certain codes are being rejected.
Now that you have all this data, put into action a plan. Use this data to help you to submit clean bills and cut back on money lost due to rejections from insurance payers and having to resubmit claims. At the same time, set up a system to track the steps that were taken to solve these billing issues.
From time to time it’s good to set up a conference call between the physician or the insurance biller or both to bring these issues up to them. All this documentation and data that has been gathered is very helpful when speaking with payers so that your point is proven with facts. You may at times have to document patterns of payment but with polite negotiations with the payer representatives you’re able to resolve issues promptly which leads to an improvement in cash flow for the office and a satisfying work
environment for all.
Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php
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